<?php defined('ByShopWWI') or exit('Access Invalid!');?> 


<div class="nc-register-bg">
  <div class="nc-register-box">
    <div class="nc-register-layout">
      <div class="left">
        <div class="nc-register-mode">
          <div id="tabs_container" class="tabs-container">
            <div class="tabmenu">
                <ul class="tab pngFix">
                    <li class="active"><a href="<?php echo urlMember('member', 'applyform')?>">申请报单中心</a></li>
                </ul>
            </div>
            <div id="default" class="ncm-default-form">
              <form id="register_form" method="post" class="nc-login-form">
                <input type="hidden" name="form_submit" value="ok" />
                <?php Security::getToken();?>
                <dl>
                  <dt>申请备注：</dt>
                  <dd>
                    <input type="text" id="remark" name="remark" class="text w270" />
                    <p class="hint">请填写申请备注信息</p>
                  </dd>
                </dl>
                <dl class="bottom">
                    <dt>&nbsp;</dt>
                    <dd>
                      <label class="submit-border">
                        <input class="submit" value="提交申请" type="submit">
                      </label>
                    </dd>
                </dl>
                
                
                
                
                <input type="hidden" value="<?php echo $_GET['ref_url']?>" name="ref_url">
                <input name="nchash" type="hidden" value="<?php echo getNchash();?>" />
                
              </form>
            </div>

         
          </div>
        </div>
      </div>
     
    </div>
  </div>
</div>


